Nutritional status-based model for predicting low-lactate shock: A retrospective cohort study.

IF 2.9 3区 医学 Q2 CRITICAL CARE MEDICINE
SHOCK Pub Date : 2025-09-23 DOI:10.1097/SHK.0000000000002710
Xiaofang Xu, Fang Hu, Zhaocai Zhang
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引用次数: 0

Abstract

Background: Although Sepsis-3.0 defines septic shock as hypotension with serum lactate levels >2.0 mmol/L, this criterion may miss low-lactate shock: a clinically significant phenotype characterized by hypotension but without elevated lactate levels. The epidemiological characteristics and prognostic significance of low-lactate shock remain unclear, highlighting a critical gap in current shock management models.

Methods: We conducted a retrospective cohort study of 3,134 patients with shock admitted to a tertiary care medical institution from January 2015 to March 2022. We used propensity score matching (1:2 ratio) to control for confounding factors, aiming to determine the prevalence of low-lactate shock (lactate ≤ 2.0 mmol/L), identify risk factors through multivariable logistic regression, and validate the predictive model (NRS-APACHE II-TG-TBIL) using ROC analysis.

Results: The 28-day mortality rate was slightly lower in the low-lactate shock group compared to the high-lactate group (25.4% [94/369] vs. 35.8% [990/2,765], respectively). The age, nutritional risk screening (NRS-2002) score, and venous thromboembolism (VTE) risk score were significantly lower in the low-lactate shock group than in the high-lactate shock group (P < 0.05). No statistically significant differences were observed in gender distribution (P = 0.092). Multivariable analysis identified four independent predictors of low-lactate shock: NRS-2002 (OR=0.570, P<0.001), APACHE II (OR=0.869, P<0.001), TG (OR=0.772, P=0.035), and TBIL (OR=0.993, P=0.002). The composite NRS-APACHE II-TG-TBIL model showed excellent discrimination (AUC=0.800, P<0.001) with balanced sensitivity (72.6%) and specificity (73.5%).

Conclusions: Low-lactate shock carries substantial mortality risk (25.4%). The validated NRS-APACHE II-TG-TBIL model (AUC=0.800) provides an effective tool for early detection, addressing critical diagnostic gaps in shock management.

基于营养状况预测低乳酸休克的模型:一项回顾性队列研究。
背景:尽管《脓毒症-3.0》将脓毒性休克定义为伴有血清乳酸水平>2.0 mmol/L的低血压,但这一标准可能会忽略低乳酸休克:一种临床显著的表型,其特征是低血压但乳酸水平不升高。低乳酸休克的流行病学特征和预后意义尚不清楚,这突出了当前休克管理模式的一个关键空白。方法:对某三级医疗机构2015年1月至2022年3月收治的3134例休克患者进行回顾性队列研究。我们采用倾向评分匹配(1:2比例)控制混杂因素,确定低乳酸休克(乳酸≤2.0 mmol/L)的患病率,通过多变量logistic回归识别危险因素,并通过ROC分析验证预测模型(NRS-APACHE II-TG-TBIL)。结果:低乳酸休克组28天死亡率略低于高乳酸休克组(25.4% [94/369]vs. 35.8%[990/ 2765])。低乳酸休克组的年龄、营养风险筛查(NRS-2002)评分、静脉血栓栓塞(VTE)风险评分均显著低于高乳酸休克组(P < 0.05)。性别分布差异无统计学意义(P = 0.092)。多变量分析确定了低乳酸休克的4个独立预测因子:NRS-2002 (OR=0.570, p)。结论:低乳酸休克具有显著的死亡风险(25.4%)。经过验证的NRS-APACHE II-TG-TBIL模型(AUC=0.800)为早期发现提供了有效的工具,解决了休克管理中的关键诊断差距。
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来源期刊
SHOCK
SHOCK 医学-外科
CiteScore
6.20
自引率
3.20%
发文量
199
审稿时长
1 months
期刊介绍: SHOCK®: Injury, Inflammation, and Sepsis: Laboratory and Clinical Approaches includes studies of novel therapeutic approaches, such as immunomodulation, gene therapy, nutrition, and others. The mission of the Journal is to foster and promote multidisciplinary studies, both experimental and clinical in nature, that critically examine the etiology, mechanisms and novel therapeutics of shock-related pathophysiological conditions. Its purpose is to excel as a vehicle for timely publication in the areas of basic and clinical studies of shock, trauma, sepsis, inflammation, ischemia, and related pathobiological states, with particular emphasis on the biologic mechanisms that determine the response to such injury. Making such information available will ultimately facilitate improved care of the traumatized or septic individual.
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